Provider Demographics
NPI:1619907193
Name:KNAPTON, SUSAN SEAGROVES (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SEAGROVES
Last Name:KNAPTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:NELL
Other - Last Name:SEAGROVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 631418
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0088
Mailing Address - Country:US
Mailing Address - Phone:817-284-9850
Mailing Address - Fax:877-992-0607
Practice Address - Street 1:8200 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:817-284-9850
Practice Address - Fax:877-992-0607
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5587208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB133236Medicare PIN